Hepatitis C infection among Dutch haemophilia patients: a nationwide cross‐sectional study of prevalence and antiviral treatment

Posthouwer, D.; Plug, Iris; Bom, Johanna G. van der; Fischer, Kathelijn; Rosendaal, Frits R.; Mauser‐Bunschoten, E. P.

doi:10.1111/j.1365-2516.2005.01083.x

Cited by 24 publications

(21 citation statements)

References 32 publications

(56 reference statements)

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“…As expected, the prevalence of HCV exposure was higher in patients with more severe bleeding disorders as a result of increased exposure to contaminated blood products. The prevalence of HCV in our haemophilia population was 72% among patients with haemophilia A or B of all severities and is similar to that reported in the Netherlands (68%) , the UK (76%) and Brazil (63%) , but lower than that reported in an American population (89%) . There are limited publications concerning HCV prevalence in patients with other bleeding disorders.…”

Section: Discussionsupporting

confidence: 86%

Prevalence of transfusion-acquired hepatitis C in an Australian bleeding disorders population

et al. 2013

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In Australia prior to 1992, many patients with bleeding disorders were exposed to hepatitis C through blood products. However, the incidence, complications and response to treatment of chronic hepatitis C (CHC) in this population are poorly characterized. The aim of this study was to examine the prevalence of CHC and response to treatment in an Australian bleeding disorders population. Demographic data, virological data and liver disease status from these 700 patients with inherited bleeding disorders were analysed. Of these 700 patients, 424 (61%) had been tested for CHC infection and 219 (52%) were hepatitis C antibody positive, with the prevalence approaching 100% in patients with severe bleeding disorders. Of 219 patients, 73 (33%) had received treatment for their infection with a response rate of 33/73 (45%) across all genotypes. Of 219 patients, 34 (16%) had spontaneous viral clearance. When measured with transient elastography, 44/98 (45%) patients with CHC had significant liver fibrosis and 15/98 (15%) had liver cirrhosis. Of 130 patients, 38 (29%) with CHC infection had no evidence of follow-up with an appropriate clinician in the past 2 years. This study demonstrates that testing for CHC in this population is incomplete and treatment rates are low. Given the substantial morbidity and mortality associated with CHC and new therapeutic options becoming available, it seems important to reengage patients to diagnose, offer treatment and monitor this infection.

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Section: Discussionsupporting

confidence: 86%

Prevalence of transfusion-acquired hepatitis C in an Australian bleeding disorders population

et al. 2013

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“…Furthermore, ESLD did not occur in patients with a SVR, whereas the cumulative incidence was 13% in those unsuccessfully treated 15 years after completing therapy, underscoring the importance of antiviral therapy. However, there are still many hemophilic patients with chronic hepatitis C who have not been treated [18]. Current guidelines recommend treatment in all patients with HCV genotype 2 and 3 [29].…”

Section: Discussionmentioning

confidence: 99%

“…However, most of these studies have been limited by a small number of patients treated, a short follow‐up, and experience with PegIFN and ribavirin has not yet been reported in peer reviewed publications. Data on response to IFN‐based therapies are of importance for both physicians and patients, as the majority of hemophilia patients with chronic hepatitis C have received no or suboptimal treatment [18]. In the present multicenter study, the response to initial IFN‐based therapy in a large cohort of patients with inherited bleeding disorders was assessed and determinants associated with response were identified.…”

Section: Introductionmentioning

confidence: 99%

Antiviral therapy for chronic hepatitis C in patients with inherited bleeding disorders: an international, multicenter cohort study

Posthouwer

Yee

Makris

et al. 2007

Journal of Thrombosis and Haemostasis

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Summary. Background: Hepatitis C is a major co-morbidity in patients with hemophilia. However, there is little information on the efficacy of antiviral therapy and long-term follow-up after treatment. Objectives: To assess the effect of interferonbased (IFN-based) therapy on hepatitis C virus (HCV) eradication, to identify determinants associated with treatment response, and to assess the occurrence of end-stage liver disease (ESLD) after completing antiviral therapy. Patients and methods: In a multicenter cohort study, 295 treatment-naı¨ve hemophilia patients chronically infected with HCV were included. The effect of therapy was expressed as sustained virological response (SVR). Determinants associated with treatment response were expressed as odds ratios (ORs). Cumulative incidence of ESLD was assessed using a KaplanMeier survival table. Results: Among human immunodeficiency virus (HIV) negative patients (n = 235), SVR was 29% (29/101) for IFN monotherapy, 44% (32/72) for IFN with ribavirin, and 63% (39/62) for pegylated IFN (PegIFN) with ribavirin. In patients co-infected with HIV (n = 60), IFN monotherapy, IFN with ribavirin, and PegIFN with ribavirin eradicated HCV in 7/35 (20%), 1/2 (50%), and 11/23 (48%), respectively. SVR increased with genotype 2 and 3 [OR 11.0,, and combination therapy (IFN and ribavirin OR 3.7, 95% CI: 1.7-8.4), PegIFN and ribavirin (OR 4.2, 95% CI: 1.8-9.5). Up to 15 years after antiviral treatment, none of the patients with a SVR relapsed and none developed ESLD. In contrast, among unsuccessfully treated patients the cumulative incidence of ESLD after 15 years was 13.0%. Conclusions: Successful antiviral therapy appears to have a durable effect and reduces the risk of ESLD considerably.

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“…Although treatment success for hepatitis C has improved over the years, the majority of patients with bleeding disorders have refused therapy, at least in the Netherlands [13]. Most patients fear side effects or expect a low efficacy.…”

Section: Discussionmentioning

confidence: 99%

“…Although patients with bleeding disorders generally have been offered treatment, at least in the Netherlands, most of them have declined therapy because of expected side effects, relatively low efficacy (generally HCV genotype 1), and an absence of symptoms of hepatitis C [13]. To determine whether therapy is strongly indicated, individual assessment of fibrosis is necessary, especially in patients with genotype 1.…”

Section: Introductionmentioning

confidence: 99%

Significant liver damage in patients with bleeding disorders and chronic hepatitis C: non‐invasive assessment of liver fibrosis using transient elastography

Posthouwer¹,

Mauser‐Bunschoten²,

Fischer

et al. 2007

Journal of Thrombosis and Haemostasis

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Summary. Background: Many patients with bleeding disorders have been infected with the hepatitis C virus (HCV), mainly with genotype 1. Antiviral treatment is only effective in 50% of these patients and is often accompanied by serious side effects. Consequently, careful selection of patients for treatment is warranted. Liver biopsies are generally not performed in these patients because of increased bleeding risk and high costs. We therefore assessed liver fibrosis and cirrhosis non‐invasively using liver stiffness measurement (LSM). Methods: We enrolled 124 patients with bleeding disorders and chronic hepatitis C. Liver fibrosis was assessed by LSM using Fibroscan®. In order to assess the validity of LSM in our hands, a separate group of 63 patients without bleeding disorders infected with HCV were evaluated with both LSM and biopsy. Results: In the validation study, liver elasticity was highly correlated with histological fibrosis stage (correlations coefficient 0.73, P < 0.001). Based on LSM, 18% of patients with bleeding disorders and chronic hepatitis C had severe fibrosis, and 17% had cirrhosis after 34 years of infection (range 14–40). However, the prevalence of cirrhosis based on laboratory and ultrasonographic findings was only 7%. Independent risk factors for an increase in LSM were older age at infection, higher body mass index, presence of viral co‐infection, and male gender. Fifteen out of 59 patients (25%) with an apparent indication for treatment (significant fibrosis by LSM) agreed to start antiviral therapy within 3 months. Conclusions: We found an unexpected high number of patients with significant fibrosis and cirrhosis in patients with bleeding disorders and hepatitis C detected by LSM, with considerable impact on the management of the disease.

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Hepatitis C infection among Dutch haemophilia patients: a nationwide cross‐sectional study of prevalence and antiviral treatment

Cited by 24 publications

References 32 publications

Prevalence of transfusion-acquired hepatitis C in an Australian bleeding disorders population

Prevalence of transfusion-acquired hepatitis C in an Australian bleeding disorders population

Antiviral therapy for chronic hepatitis C in patients with inherited bleeding disorders: an international, multicenter cohort study

Significant liver damage in patients with bleeding disorders and chronic hepatitis C: non‐invasive assessment of liver fibrosis using transient elastography

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